Both Dr McMahen (“Ready or not” BCMJ 2009;51:190) and Mr Littlejohn raise the importance of highly functional EMRs and lab interfaces, as well as physician leadership and input.
I have had the privilege of meeting well over 1000 physicians from across the province and will offer two observations regarding the functionality of EMRs and physician adoption in BC.
First, many physicians in BC are making extraordinary use of very powerful functionality in their EMRs and showing demonstrable positive impact on both quality of patient care and outcomes and on their own work satisfaction and quality of life.
They are capturing data in flowsheets, graphing lab values against medications to better assess dosage changes, receiving automatic alerts and reminders, producing recall lists and run charts to support chronic disease management, receiving electronic diagnostic reports, capturing data in sophisticated templates, catching up on chart review remotely from home, producing powerful data for their clinical research, and more.
Second, outside of these more advanced users, the majority of physicians who have adopted EMRs are only using a fraction of the available functionality, usually because they lack the free time and easily accessible advanced training needed to maximize their use of the EMR. For this reason PITO is developing a post-implementation support service to assist physicians in getting the most from their EMRs. Preliminary response regarding this service has been very positive.
I must correct some statements regarding the lab interface in Interior Health. Interior Health is in fact leading the way in BC and Canada by providing electronic delivery of not only lab results from all of its hospitals and labs but also diagnostic imaging reports and hospital transcribed reports (discharge, operative, and consult reports).
Dr McMahen suggests that only one EMR has connected to Interior Health’s interface. In fact, at the time of writing, seven EMR systems had been connected to the Interior Health interface and four more are in progress. Out of the five PITO-qualified vendors, four have already connected to the Interior Health interface and the fifth is in final testing. The latest details can be found at www.interiorhealth.ca/information.aspx?id=2808.
Regarding EMR uptake, Dr McMahen voiced concern that “BC doctors are not exactly beating a path to the EMR door”; however, the enrollment to date would suggest otherwise. By April of this year 2000 physicians had enrolled in the PITO program to implement an EMR, already reaching the target set for the end of the year, and the program has been oversubscribed in every enrollment to date.
I am pleased to confirm that the design of the PITO program and the determination of the functionality required of the PITO-qualified EMRs did indeed follow the approach that Dr McMahen and Mr Littlejohn suggest by involving a large group of BC physicians and extensive conformance testing prior to the first pilot implementations. With the program now well underway it is continually refined with the input of over 40 actively involved physician peer champions and the lessons gleaned as every physician implements.
PITO Program Director
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org